Evaluation of the non-invasive brain compliance curve in pediatric patients undergoing liver transplantation

• Grant number: 24/23619-0
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: April 01, 2025
• End date: March 31, 2026
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Vinícius Caldeira Quintão
• Grantee: Rhuan Pimentel Nogueira
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

The study in question aims to evaluate the non-invasive cerebral compliance curve in pediatric patients undergoing liver transplantation. To this end, it uses the cerebral compliance monitoring system, wired (brain4care®) or wireless (brain4care® - BWS model) marketed by BrainCare®, also using the BIS anesthetic depth monitoring system, marketed by Medtronic®. This is a clinical, prospective, observational and single-center study, with the objective of describing the characteristics of the intracranial compliance curve using the brain4care® device in the pediatric population undergoing elective liver transplant surgery. The study population consists of pediatric patients with indication for elective liver transplant surgery performed at the Children and Adolescent Institute of the Hospital das Clínicas of the University of São Paulo School of Medicine (ICr-HCFMUSP). Pediatric patients aged between zero and 12 years who underwent elective liver transplant surgery with living relatives and whose guardians signed the informed consent form were included. Therefore, the exclusion criteria are refusal to sign the informed consent form by guardians and history of previous neurological pathologies that increase intracranial pressure. The primary outcomes are to observe the characteristics of the cerebral compliance curve measured by the noninvasive brain4care® device in pediatric patients undergoing surgery, while the secondary outcome is to observe the correlation of cerebral compliance values ¿¿with anesthetic depth values. Throughout the study, the following procedures will be performed: On the day before surgery, guardians of potential patients will be invited to sign the informed consent form. Afterwards, a pre-anesthetic evaluation will be performed. Patients will be monitored at the beginning of surgery with continuous 5-lead cardioscope, pulse oximetry, invasive blood pressure, non-invasive intracranial pressure sensor (brain4care®) and depth of anesthesia (BIS). Measurements of intracranial compliance (brain4care®) and BIS will be performed at the following times: before anesthetic induction, during the intraoperative period and after emergence from anesthesia. Finally, demographic data, comorbidities and clinical data will be collected from the medical records. Intraoperative characteristics such as duration of surgery, exposure to blood components, laboratory data and complications during surgery will be recorded. The sensor and fixation tape of the intracranial pressure monitor will be fixed to the parietal bone. The BIS electrodes will be aligned on the patient's forehead. In the postoperative period, length of hospital stay and survival status will be recorded.